Valve-sparing root reconstruction does not compromise survival in acute type a aortic dissection

Sreekumar - Subramanian, Sergey Leontyev, Michael A. Borger, Constanze Trommer, Martin Misfeld, Friedrich W. Mohr

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures. Methods: The Heart Center database (Leipzig, Germany) was reviewed to identify patients who underwent a VSRR for acute type A aortic dissection (AAAD) repair. Patients were classified into 3 groups: Bentall (biological or mechanical valved conduit), Yacoub VSRR, and David VSRR. Intergroup comparisons were performed using the t test and analysis of variance as appropriate. Results: From March 1995 to April 2010, 208/374 patients (56%) undergoing AAAD repair received an aortic root procedure. Group 1 (n = 130) underwent a Bentall operation, group 2 (n = 51) underwent a modified Yacoub procedure, and group 3 (n = 27) underwent a modified David procedure. Age and logistic European system for cardiac operative risk evaluation (EuroSCORE) as well as cross-clamp, cardiopulmonary bypass, and circulatory arrest times were similar among the groups. Hospital mortality among all 3 groups was similar (group 1, 27%; group 2, 16%; group 3, 15%). At a mean follow-up of 44 months for group 2 and 27 months for group 3, there was no difference in the need for aortic valve replacement for moderate to severe aortic insufficiency (AI) (2/37 survivors in group 2 versus 1/23 survivors in group 3; z score = -0.279; p > 0.05). Five-year survival estimates were 66% for group 1, 65% for group 2, and 80% for group 3 (log rank p = 0.2). Conclusions: Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.

Original languageEnglish (US)
Pages (from-to)1230-1234
Number of pages5
JournalAnnals of Thoracic Surgery
Volume94
Issue number4
DOIs
StatePublished - Oct 2012

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Dissection
Survival
Aortic Valve
Survivors
Hospital Mortality
Cardiopulmonary Bypass
Germany
Analysis of Variance
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Valve-sparing root reconstruction does not compromise survival in acute type a aortic dissection. / Subramanian, Sreekumar -; Leontyev, Sergey; Borger, Michael A.; Trommer, Constanze; Misfeld, Martin; Mohr, Friedrich W.

In: Annals of Thoracic Surgery, Vol. 94, No. 4, 10.2012, p. 1230-1234.

Research output: Contribution to journalArticle

Subramanian, Sreekumar - ; Leontyev, Sergey ; Borger, Michael A. ; Trommer, Constanze ; Misfeld, Martin ; Mohr, Friedrich W. / Valve-sparing root reconstruction does not compromise survival in acute type a aortic dissection. In: Annals of Thoracic Surgery. 2012 ; Vol. 94, No. 4. pp. 1230-1234.
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title = "Valve-sparing root reconstruction does not compromise survival in acute type a aortic dissection",
abstract = "Background: The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures. Methods: The Heart Center database (Leipzig, Germany) was reviewed to identify patients who underwent a VSRR for acute type A aortic dissection (AAAD) repair. Patients were classified into 3 groups: Bentall (biological or mechanical valved conduit), Yacoub VSRR, and David VSRR. Intergroup comparisons were performed using the t test and analysis of variance as appropriate. Results: From March 1995 to April 2010, 208/374 patients (56{\%}) undergoing AAAD repair received an aortic root procedure. Group 1 (n = 130) underwent a Bentall operation, group 2 (n = 51) underwent a modified Yacoub procedure, and group 3 (n = 27) underwent a modified David procedure. Age and logistic European system for cardiac operative risk evaluation (EuroSCORE) as well as cross-clamp, cardiopulmonary bypass, and circulatory arrest times were similar among the groups. Hospital mortality among all 3 groups was similar (group 1, 27{\%}; group 2, 16{\%}; group 3, 15{\%}). At a mean follow-up of 44 months for group 2 and 27 months for group 3, there was no difference in the need for aortic valve replacement for moderate to severe aortic insufficiency (AI) (2/37 survivors in group 2 versus 1/23 survivors in group 3; z score = -0.279; p > 0.05). Five-year survival estimates were 66{\%} for group 1, 65{\%} for group 2, and 80{\%} for group 3 (log rank p = 0.2). Conclusions: Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.",
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AU - Subramanian, Sreekumar -

AU - Leontyev, Sergey

AU - Borger, Michael A.

AU - Trommer, Constanze

AU - Misfeld, Martin

AU - Mohr, Friedrich W.

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N2 - Background: The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures. Methods: The Heart Center database (Leipzig, Germany) was reviewed to identify patients who underwent a VSRR for acute type A aortic dissection (AAAD) repair. Patients were classified into 3 groups: Bentall (biological or mechanical valved conduit), Yacoub VSRR, and David VSRR. Intergroup comparisons were performed using the t test and analysis of variance as appropriate. Results: From March 1995 to April 2010, 208/374 patients (56%) undergoing AAAD repair received an aortic root procedure. Group 1 (n = 130) underwent a Bentall operation, group 2 (n = 51) underwent a modified Yacoub procedure, and group 3 (n = 27) underwent a modified David procedure. Age and logistic European system for cardiac operative risk evaluation (EuroSCORE) as well as cross-clamp, cardiopulmonary bypass, and circulatory arrest times were similar among the groups. Hospital mortality among all 3 groups was similar (group 1, 27%; group 2, 16%; group 3, 15%). At a mean follow-up of 44 months for group 2 and 27 months for group 3, there was no difference in the need for aortic valve replacement for moderate to severe aortic insufficiency (AI) (2/37 survivors in group 2 versus 1/23 survivors in group 3; z score = -0.279; p > 0.05). Five-year survival estimates were 66% for group 1, 65% for group 2, and 80% for group 3 (log rank p = 0.2). Conclusions: Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.

AB - Background: The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures. Methods: The Heart Center database (Leipzig, Germany) was reviewed to identify patients who underwent a VSRR for acute type A aortic dissection (AAAD) repair. Patients were classified into 3 groups: Bentall (biological or mechanical valved conduit), Yacoub VSRR, and David VSRR. Intergroup comparisons were performed using the t test and analysis of variance as appropriate. Results: From March 1995 to April 2010, 208/374 patients (56%) undergoing AAAD repair received an aortic root procedure. Group 1 (n = 130) underwent a Bentall operation, group 2 (n = 51) underwent a modified Yacoub procedure, and group 3 (n = 27) underwent a modified David procedure. Age and logistic European system for cardiac operative risk evaluation (EuroSCORE) as well as cross-clamp, cardiopulmonary bypass, and circulatory arrest times were similar among the groups. Hospital mortality among all 3 groups was similar (group 1, 27%; group 2, 16%; group 3, 15%). At a mean follow-up of 44 months for group 2 and 27 months for group 3, there was no difference in the need for aortic valve replacement for moderate to severe aortic insufficiency (AI) (2/37 survivors in group 2 versus 1/23 survivors in group 3; z score = -0.279; p > 0.05). Five-year survival estimates were 66% for group 1, 65% for group 2, and 80% for group 3 (log rank p = 0.2). Conclusions: Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.

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